Lever sign test for anterior cruciate ligament injuries: a diagnostic meta-analysis

Review written by Dr Michael Reiman info

Key Points

  1. The authors report that “with high specificity and sensitivity, the lever sign is a reliable diagnostic modality for ACL injuries.” I do not believe their data supports such a statement.
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BACKGROUND & OBJECTIVE

The three most studied tests for ACL tear, the Lachman, the pivot shift, and the anterior drawer test, have shown adequate overall accuracy for clinical use (1-4). However, these tests also yielded lower accuracy when utilized acutely post-injury compared to a chronic tear (4), when the knee has a combined lesion to the meniscus instead of an isolated ACL tear, and when the tear is partial compared to complete (1-4). The accuracy of these tests may also be lower when non-expert clinicians execute them because of technical difficulties and interpretation of the outcomes (5,6).

In response to these limitations, Lelli et al. proposed a new physical examination test called the lever sign to diagnose ACL tears (7). See lever sign test video for demonstration. This test has gained increasing interest due to its simplicity. Additionally, many reviews have examined its clinical utility. This meta-analysis is the latest assessment of the accuracy of the lever sign.

LEVER SIGN TEST https://youtu.be/tqYpVR0R_NU

The three most studied tests for ACL tear, the Lachman, the pivot shift, and the anterior drawer test, have shown adequate overall accuracy for clinical use.
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The clinical implication suggests poorer clinical utility of the lever sign since our review in 2018, where there is a moderate and imprecise shift in post-test probability due to a positive lever sign.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized. Exclusion criteria were (1) the study was a review article, conference abstract, or case report; (2) the investigation did not report primary data; (3) the study did

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